Abstract
Recent increases in the incidence and severity of staphylococcal infections renewed interest in studies that assess the burden of asymptomatic carriage of Staphylococcus aureus in the community setting. We conducted a population-based survey in the city of Botucatu, Brazil (122,000 inhabitants), in order to identify the prevalence of nasal carriage of Staphylococcus aureus (including methicillin-resistant strains). Nasal swabs were obtained from 686 persons over one year of age. Resistance to methicillin was assessed through phenotypic methods, identification of the mecA gene and typing of the Staphylococcal Chromosome Cassette mec (SCCmec). Methicillin-resistant S. aureus (MRSA) isolates were characterized using Pulsed-Field Gel Electrophoresis (PFGE), Multilocus Sequence Typing (MLST) and spa typing. Polymerase chain reaction was applied to identify genes coding for Panton-Valentine Leukocidin (PVL) in isolates. The prevalence of overall S. aureus carriage was 32.7% (95%CI, 29.2%–36.2%). Carriers were significantly younger (mean age, 28.1 versus 36.3 for non-carriers; OR for age, 0.98; 95%CI, 0.97–0.99) and likely to report recent skin infection (OR, 1.85; 95%CI, 1.03–3.34). Carriage of methicillin-resistant S. aureus (MRSA) was found in 0.9% of study subjects (95%CI, 0.4%–1.8%). All MRSA isolates harbored SCCmec type IV, and belonged to spa types t002 or t021, but none among them harbored genes coding for PLV. In MLST, most isolates belonged to clones ST5 or ST1776. However, we found one subject who carried a novel clone, ST2594. Two out of six MRSA carriers had household contacts colonized with isolates similar to theirs. Our study pointed to dissemination of community-associated MRSA among the Brazilian population.
Highlights
Recent reports point out to an increase in incidence and severity of staphylococcal infections arising in the community [1,2]
Others enrolled specific age groups, such as children [39,40,41] and elderly persons [41]. While these studies are of great interest, it is still necessary to estimate the burden of S. aureus and Methicillin-resistant S. aureus (MRSA) carriage among general population from different countries
Our findings point out to a prevalence of both S. aureus and MRSA colonization similar to that reported in the 2001–2002 National Health and Nutrition Examination Survey (NHANES) reports [16,17] and in minor studies from the U.S [42,43]
Summary
Recent reports point out to an increase in incidence and severity of staphylococcal infections arising in the community [1,2]. One study conducted in five major African towns, including 542 patients with S. aureus infections, identified 86 MRSA isolates, of which 9 were classified as CA-MRSA [8] Those cases accounted for 11.5% of community-associated S. aureus infections, though data may be biased due to criteria for collecting cultures [9]. In order to identify the sources and dynamics of CA-MRSA in the general population, some epidemiological studies addressed the prevalence and determinants of asymptomatic carriage ( termed ‘‘colonization’’) of S. aureus and MRSA in the community setting. Those studies are based on the evidence that colonization represents a reservoir for pathogenic strains and/or a preinfectious stage [14,15]. We aimed to identify factors associated to colonization and the molecular epidemiology of colonizing strains
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